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General NPI Number Information
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NPI Number | 1851589519
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Entity Type | Organization
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Legal Business Name | VADIM CHUDNOVSKY, M.D., INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1440 S STATE COLLEGE BLVD SUITE 3-M
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City | ANAHEIM
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State | CA
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Zip | 92806-5724
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Country | US
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Telephone | 714-758-2985
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Fax | 714-758-0770
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Provider Business Mailing Address
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Address Line | 1440 S STATE COLLEGE BLVD SUITE 3-M
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City | ANAHEIM
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State | CA
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Zip | 92806-5724
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Country | US
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Telephone | 714-758-2985
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Fax | 714-758-0770
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VADIM CHUDNOVSKY
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Credential | M.D.
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Telephone | 714-758-2985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A48658
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License Number State | CA
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